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To the Editor:
Re "We Can Be Healthy and Rich" (Sunday Review, Feb. 3):
Ezekiel Emanuel's declaration that everyone except "hospitals and the unions representing hospital workers" agrees that "something must be done to control the rising costs" is a useless generality. Hospitals and their medical staffs, such as Beth Israel Deaconess Medical Center in Boston, have instituted programs to control the costs of medical care and strengthen its quality and value. So has Kaiser Permanente for years.
The shape of health care and its costs are determined primarily by the way care is paid for. Today, fee-for-service remains the dominant mode of payment. Until that changes to a fair annual average cost limit per patient, the nation's approach to cost, quality and value will remain flawed.
MITCHELL T. RABKIN
Milton, Mass., Feb. 4, 2013
The writer is a professor of medicine at Harvard Medical School and former chief executive of Beth Israel Hospital.
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